急危重症医学卫生服务研究中的初级和次级数据 - 多模态患者区域研究网络中的比较分析。

Primary and secondary data in emergency medicine health services research - a comparative analysis in a regional research network on multimorbid patients.

机构信息

Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany.

Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.

出版信息

BMC Med Res Methodol. 2023 Feb 4;23(1):34. doi: 10.1186/s12874-023-01855-2.

DOI:10.1186/s12874-023-01855-2

PMID:36739382

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9898937/

Abstract

BACKGROUND

This analysis addresses the characteristics of two emergency department (ED) patient populations defined by three model diseases (hip fractures, respiratory, and cardiac symptoms) making use of survey (primary) and routine (secondary) data from hospital information systems (HIS). Our aims were to identify potential systematic inconsistencies between both data samples and implications of their use for future ED-based health services research.

METHODS

The research network EMANET prospectively collected primary data (n=1442) from 2017-2019 and routine data from 2016 (n=9329) of eight EDs in a major German city. Patient populations were characterized using socio-structural (age, gender) and health- and care-related variables (triage, transport to ED, case and discharge type, multi-morbidity). Statistical comparisons between descriptive results of primary and secondary data samples for each variable were conducted using binomial test, chi-square goodness-of-fit test, or one-sample t-test according to scale level.

RESULTS

Differences in distributions of patient characteristics were found in nearly all variables in all three disease populations, especially with regard to transport to ED, discharge type and prevalence of multi-morbidity. Recruitment conditions (e.g., patient non-response), project-specific inclusion criteria (e.g., age and case type restrictions) as well as documentation routines and practices of data production (e.g., coding of diagnoses) affected the composition of primary patient samples. Time restrictions of recruitment procedures did not generate meaningful differences regarding the distribution of characteristics in primary and secondary data samples.

CONCLUSIONS

Primary and secondary data types maintain their advantages and shortcomings in the context of emergency medicine health services research. However, differences in the distribution of selected variables are rather small. The identification and classification of these effects for data interpretation as well as the establishment of monitoring systems in the data collection process are pivotal.

TRIAL REGISTRATION

DRKS00011930 (EMACROSS), DRKS00014273 (EMAAGE), NCT03188861 (EMASPOT).

摘要

背景

本分析利用医院信息系统（HIS）中的调查（主要）和常规（次要）数据，针对由三种模型疾病（髋部骨折、呼吸和心脏症状）定义的两个急诊科（ED）患者群体的特征进行了研究。我们的目的是确定两种数据样本之间潜在的系统不一致，并探讨其在未来基于 ED 的卫生服务研究中的应用意义。

方法

研究网络 EMANET 于 2017 年至 2019 年期间前瞻性地从德国一个主要城市的 8 个 ED 中收集了 1442 名患者的主要数据，并于 2016 年收集了 9329 名患者的常规数据。利用社会结构（年龄、性别）和健康及护理相关变量（分诊、送往 ED 的交通方式、病例和出院类型、多病共存）来描述患者群体特征。对于每个变量，使用二项式检验、卡方拟合优度检验或单样本 t 检验，根据量表水平比较主要和次要数据样本的描述性结果。

结果

在所有三种疾病人群中，几乎所有变量的患者特征分布都存在差异，尤其是在送往 ED 的交通方式、出院类型和多病共存的患病率方面。招募条件（例如，患者无响应）、项目特定的纳入标准（例如，年龄和病例类型限制）以及数据生成的记录常规和实践（例如，诊断编码）都会影响主要患者样本的构成。招募程序的时间限制不会导致主要和次要数据样本特征分布产生有意义的差异。